title: Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case.
abstract: We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction.
authors.affiliation: Department of Cardiovascular Surgery, Tomishiro Central Hospital, 25 Ueta, Tomigusuku-city, Okinawa, 901-0243, Japan. makohashi1001@hotmail.co.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Cardiovascular Surgery, Tomishiro Central Hospital, 25 Ueta, Tomigusuku-city, Okinawa, 901-0243, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yamauchi
authors.affiliation: Department of Surgery, Tomishiro Central Hospital, Tomigusuku-city, Okinawa, Japan.
authors.forename: Masamori
authors.initials: M
authors.lastname: Shimabuku
authors.affiliation: Department of Cardio-Thoracic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
mesh_terms: D000368:Aged; D044684:Colon, Transverse; D003108:Colonic Diseases / Q000209:etiology*; D005260:Female; D006547:Hernia / Q000209:etiology*; D006801:Humans; D008480:Mediastinitis / Q000601:surgery*; D008482:Mediastinum / Q000601:surgery; D054843:Negative-Pressure Wound Therapy; D009852:Omentum / Q000637:transplantation; D016868:Serratia Infections; D012706:Serratia marcescens; D013524:Surgical Flaps / Q000009:adverse effects*
keywords: Acute mediastinitis; Herniation of transverse colon; Mediastinum; Pedicled omental grafting; Total arch replacement